Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are both neurodevelopmental conditions that affect brain development and functioning, yet they present with distinct patterns of symptoms and challenges.
While ADHD is primarily characterized by difficulties with attention, impulse control, and hyperactivity, autism is defined by differences in social communication and restricted, repetitive patterns of behavior and interests.
Key Takeaways
Different core features: ADHD is primarily characterized by inattention, hyperactivity, and impulsivity affecting executive function, while autism is defined by persistent differences in social communication and restricted, repetitive behaviors or interests, though both conditions involve executive function deficits affecting attention, planning, and cognitive flexibility.
High co-occurrence rate: Research indicates that approximately 50-70% of individuals with autism also meet criteria for ADHD, and those with both conditions typically experience more severe symptoms and functional impairment than those with either condition alone.
Social differences matter: A critical distinction is that children with ADHD typically have the social knowledge needed for friendships but struggle with execution due to impulsivity and inattention, while children with autism have fundamental social knowledge deficits and don't inherently understand how to develop social relationships without explicit instruction.
What is ADHD?
Attention-deficit/hyperactivity disorder is a neurodevelopmental disorder characterized by persistent patterns of inattention and/or hyperactivity-impulsivity that interfere with functioning and development.
According to the 2022 National Survey of Children’s Health (NSCH), around 11.4% of children (over 7 million) aged 3-17 had an ADHD diagnosis.
Among adults, 6% of Americans (around 15.5 million) had a current ADHD diagnosis based on data from a 2023 survey published by the Centers for Diseases and Prevention.
What is Autism Spectrum Disorder?
Autism spectrum disorder is a neurodevelopmental condition characterized by persistent differences in social communication and social interaction, along with restricted, repetitive patterns of behavior, interests, or activities. Individuals with ASD may also have difficulties with sensory processing. The "spectrum" nature reflects the wide variation in the type and severity of symptoms people experience.
According to recent data from the CDC, 1 in 31 (3.2%) children aged 8 years were diagnosed with ASD.
Key Differences Between ADHD and Autism
While both conditions affect neurodevelopment, they have distinct core features and manifestations.
Social Functioning: Knowledge vs. Execution
One of the most important distinctions involves social difficulties, which present differently in each condition.
According to research published in Frontiers in Psychiatry, children with ADHD have the social knowledge needed to make friendships and develop socially; they understand what to do, but find it difficult to develop social connections with peers due to difficulties with inhibition and sustained attention. They know the social rules but struggle to execute appropriate behaviors consistently. For instance, they may miss social cues, speak out of turn, or have difficulty waiting in line.
Conversely, children with autism may find it difficult to build social connections due to their differences in social learning and social cognition. For instance, children with ASD often don’t make sufficient eye contact or display shared attention with their peers due to restricted interests. They may need more explicit instruction or support to understand social cues and relationship-building.
When children with autism receive clinical social skills training, they show much more improvement than children with ADHD, who already possess the knowledge but struggle with consistent application.
Attention Differences
ADHD: Individuals with ADHD typically have a short attention span, are quickly distracted, and find it difficult to sustain focus or shift attention appropriately. The attention problems they face affect many activities and are a core, defining feature of this condition.
Autism: In people with autism, attention differences tend to involve difficulty shifting focus from preferred topics, intense sustained attention to areas of interest (sometimes informally called "hyperfocus"), and challenges with joint attention (sharing attention with another person on the same object or event), particularly to topics they don’t find interesting.
As one clinical description notes, autistic attention impairments are more the "not listening" and "difficulty shifting focus" type than the "short attention span" and "excessive distractibility" type seen in ADHD.
Response to Routine and Change
ADHD: People with ADHD often experience difficulty maintaining routines due to poor organization and follow-through. They may actually crave novelty and become easily bored with repetitive activities.
Autism: People with autism struggle with cognitive flexibility, which involves the ability to adapt to unexpected changes. They have a strong preference for routines and sameness. People with autism often find comfort in predictability and may experience significant distress when routines are disrupted.
Sensory Experiences
ADHD: May seek sensory stimulation (fidgeting, moving, making noise) due to restlessness and need for activity.
Autism: Often involves atypical sensory processing: either hypersensitivity (overwhelmed by sensory input like loud noises, bright lights, or certain textures) or hyposensitivity (seeking intense sensory experiences, appearing unaware of pain or temperature). These sensory differences are a diagnostic criterion for autism but not ADHD.
Special Interests
ADHD: Interests may change frequently; difficulty maintaining sustained interest except during hyperfocus episodes on preferred activities. Interests are generally typical for age and cultural context.
Autism: Often features intense, sometimes uncommon interests that persist over time and may be unusual in focus or intensity. These restricted interests are a core diagnostic feature.
Similarities and Overlapping Features
Despite their differences, ADHD and autism share several characteristics that can complicate diagnosis.
Neurodevelopmental Origin
Both are neurodevelopmental disorders affecting the central nervous system, which is responsible for movement, language, memory, and social and focusing skills. Research suggests both conditions involve differences in brain structure and development, particularly in areas involved in executive functioning.
Executive Function Deficits
Both conditions involve deficits in executive functioning, though with some differences in specific profiles. Both groups show challenges with:
Working memory
Cognitive flexibility
Planning and organization
Inhibitory control
However, recent research suggests that difficulties with attention control may help explain why ADHD and autism often overlap, acting as a shared feature that connects both conditions.
Emotional Regulation Challenges
Both conditions commonly involve difficulty managing and regulating emotions. People with either ADHD or autism may experience:
Intense emotional reactions
Difficulty calming down after emotional upset
Problems identifying and expressing emotions
Low frustration tolerance
Social Difficulties
While the nature of social challenges differs, both conditions affect social functioning. With ADHD, social dysfunction stems from inhibitory and attention problems, while in autism, the dysfunction involves differences in social cognition, limited interests, or repetitive behaviors. Both conditions result in difficulties with peer relationships.
Higher Risk Demographics
Both ADHD and autism are diagnosed more frequently in males than females, though this gender difference is more pronounced in autism. However, growing research suggests that females are often underdiagnosed or diagnosed later, partly due to different symptom presentations and compensatory strategies. Additionally, both conditions tend to run in families, suggesting genetic components.
ADHD and Autism Co-occurrence
The overlap between ADHD and autism is substantial and clinically significant.
Prevalence of Co-occurring ADHD and Autism
According to research published in Autism Research, prevalence studies conducted in a school population show:
Within the scope of the study, 32.76% of children with autism also met the criteria for ADHD
Conversely, 9.84% of children with ADHD show clinically significant autism symptoms
Only 15.8% of children with co-occurring autism and ADHD had been previously diagnosed with both conditions
A meta-analysis examining the prevalence of ADHD in individuals with autism found rates ranging from 50-70%, highlighting the significant overlap between these conditions.
Treatment Approaches
Treatment strategies differ for ADHD and autism, though some interventions benefit both conditions.
Treating ADHD
Medication: Stimulant medications (methylphenidate, amphetamines) are first-line treatment for ADHD and highly effective for most people. Non-stimulant options include atomoxetine and guanfacine.
Behavioral interventions: Parent training, behavioral classroom management, organizational skills training, and cognitive-behavioral therapy help develop coping strategies and skills.
Educational supports: Accommodations like extended time, frequent breaks, preferential seating, and reduced distractions.
Treating Autism
Behavioral therapies: Behavioral interventions, including Applied Behavior Analysis (ABA), have a substantial evidence base for improving intellectual function and adaptive behaviors in autistic children. Can be used in combination with developmental, educational, and supportive therapies based on personal values and needs. Discrete trial training (DTT) and pivotal response training (PRT) are two approaches to behavioral training.
Social skills training: Explicit instruction in social rules, perspective-taking, conversation skills, and friendship development.
Speech and language therapy: For communication differences.
Occupational therapy: Often addresses sensory integration (to improve responses to sensory inputs) and daily living skills.
Medication: While no medication treats core autism symptoms, medications may address co-occurring conditions like anxiety, aggression, or irritability. Atypical antipsychotics such as aripiprazole and risperidone are FDA-approved to treat irritability, aggression, and self-harm in ASD. SSRIs may also be prescribed to treat irritability and aggression.
Treating Co-occurring ADHD and Autism
When both conditions are present, treatment becomes more complex and must be individualized.
Studies suggest that stimulant medications used to treat ADHD in individuals with both conditions may be less effective and more likely to cause side effects, including social withdrawal, depression, and irritability, than when treating ADHD alone. This highlights the importance of careful medication management and close monitoring.
Other treatment options that are currently being researched include Repetitive Transcranial Magnetic Stimulation (rTMS) and Transcranial Direct Current Stimulation (tDCS).
Currently, treatment for co-occurring conditions typically involves:
Lower starting doses of ADHD medications (than for ADHD alone) with gradual titration
Careful monitoring for side effects
Combining medication and behavioral interventions
Addressing ADHD symptoms to improve engagement in autism therapies
Comprehensive approach targeting both sets of symptoms
Research generally supports the use of psychopharmacological treatments to alleviate ADHD symptoms in patients with co-occurring ADHD and ASD. This can prove helpful as strengthening attention through ADHD treatment can make autism interventions, like social skills training and language development, much more effective, although more studies are required.
Medical Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. If you are experiencing a mental health crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.
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